Diagnosis and treatment of giant colonic fecalith in a child: a case report

Abstract

Fecaliths are concretions composed of undigested or partially digested substances formed within the gastrointestinal lumen, potentially causing obstruction or partial obstruction. The most common type of fecalith is phytobezoar, composed of plant fibers. Due to their high cellulose, hemicellulose, and lignin content, phytobezoars remain undigested within the stomach and intestines, causing blockage in the narrowest portions of the gastrointestinal tract. Obstructions caused by fecaliths typically occur in the stomach and small intestine, whereas colonic obstructions are rare, particularly in pediatric cases. In this study, we report for the first time a case of colonic obstruction caused by a giant fecalith measuring 6 cm × 6 cm, which was successfully managed by colonoscopy-assisted manual extraction under general anesthesia.

Keywords: colonic stone; fecalith; intestinal obstruction; manual extraction; phytobezoar.

Figure 1

(A) Coronary view showing distended large bowel loops up to the distal descending colon where a well-defined ovoid intraluminal mass with a mottled gas pattern is seen. (B) ransverse view showing a large mass in a circular cavity of the sigmoid colon with a dilated loop of the large intestine.

Figure 2

A barium enema examination (A and B are respectively the anteroposterior and lateral X-ray films of the abdomen) revealed a large filling defect about 6 cm in diameter at the junction of the sigmoid colon and rectum, almost complete obstruction of the colon, resulting in fecal retention.

Figure 3

(A) Impacted bezoar seen with complete obstruction is seenon colonoscopy. (B) A 6 cm × 6 cm round-shaped bezoar was removed from the colon. (C) The intestinal cavity of the colon after removal of the fecalith.